Direct intervention is needed

Gates et al conclude that the evidence base is weak for the effectiveness of multifactorial interventions to prevent falls in primary care, the community, and emergency care.1 However, the 19 studies they reviewed are not all trials of multifactorial assessments and targeted interventions.

These 19 trials require sorting into three more clinically relevant groups: those that are not truly multifactorial (three), those entailing assessment and referral but no direct intervention (10), and those entailing multifactorial assessment and direct intervention (six).

Analysed in this way, four of the six trials in the more important third group are either clearly positive or had a favourable risk ratio but insufficient power, and only two were negative. Seven of the 10 trials of assessment and referral, but without direct intervention, were negative. In one of the three trials of physical therapy, falls were not a primary or secondary outcome measure, so it should not be considered a fall prevention trial.

When similar trials are grouped together, the importance and effectiveness of direct intervention for multiple risk factors is seen for preventing falls.2